Aim To investigate the level of serum tp53-induced glycolysis and apoptotic and regulator (TIGAR) mRNA in patients with acute ischemic stroke and its relationship with prognosis. Methods 247 patients with acute ischemic stroke were selected as the study object. The age, sex, body mass index, hypertension, hyperlipidemia, diabetes, coronary heart disease, smoking, stroke distribution, stroke onset time, toast etiology, severity, stroke focus number, hemorrhage transformation, homocysteine (Hcy), C-reactive protein (CRP), D-Dimer (D-D), hemoglobin A1c (HbA1c), angiopoietin-1 (Ang-1) of patients were collected. Real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the relative expression of serum TIGAR mRNA, and its relationship with prognosis was analyzed. Results The incidence of poor prognosis in 247 patients with acute ischemic stroke was 47.77% within 90 days. The relative expression of TIGAR mRNA in the prognosis group was significantly higher than that in the poor prognosis group, and the difference was statistically significant (P＜0.05). The area under the curve AUC, sensitivity and specificity of TIGAR mRNA in evaluating the prognosis of patients with acute ischemic stroke were 0.6,8.14% and 80.62%, respectively.Logistic multivariate regression analysis showed that the onset time of stroke, TOAST etiology classification, severity, hemorrhagic transformation and TIGAR mRNA were closely related to the prognosis of patients with acute ischemic stroke. Conclusion The higher the relative expression of TIGAR mRNA in serum, the better the prognosis of patients with acute ischemic stroke. Detection of relative expression of TIGAR mRNA is helpful to assess the prognosis of patients.